# Evaluation of antibiotic prescribing for the treatment of male community-acquired urinary tract infections using reimbursement data

## TL;DR

This study evaluates how well French doctors follow guidelines when prescribing antibiotics for male urinary tract infections, finding significant variation in adherence.

## Contribution

The study introduces a method to identify doctors with poor adherence to antibiotic prescribing guidelines using reimbursement data.

## Key findings

- Compliance with French antibiotic guidelines was 55.7% for empirical treatment and 68.1% for documented treatment.
- Three clusters of GPs were identified with adherence rates of 22%, 44%, and 77%.
- Treatment durations for fluoroquinolones and cotrimoxazole were often too short and varied between GPs.

## Abstract

Urinary tract infection (UTI) in men, although less common than in women, present specific diagnostic and therapeutic challenges. This study aims to evaluate the prescribing practices of general practitioners (GPs) for male UTI in France, focusing on adherence to guidelines.

We used an anonymous reimbursement database of antibiotics prescribed 15 days around an urine culture between September 2019 and August 2022 in a French region. Antibiotic prescriptions for male UTI were analysed according to adherence to national guidelines. Cluster analysis was used to identify different GP prescribing profiles. Prescription duration was assessed according to the number of antibiotic boxes delivered in the community pharmacy.

We included 7,816 urine culture prescriptions from 940 GPs for 6,457 male patients. We estimated compliance with French recommendations to be 55.7% for empirical treatment and 68.1% for documented treatment. GPs were divided into three clusters with different adherence to recommendations of 22%, 44% and 77%. Treatment duration for fluoroquinolones and cotrimoxazole was heterogeneous between GPs, but mainly too short.

Our results suggest that our method could identify GPs who do not prescribe in accordance with recommendations and enable health insurance systems to target educational interventions to improve antibiotic prescribing practices.